Preventing Conflicts of Interest of NFL Team Physicians

Mark A. Rothstein

The Hastings Center Report

Originally posted November 21, 2016

Abstract

At least since the time of Hippocrates, the physician-patient relationship has been the paradigmatic ethical arrangement for the provision of medical care. Yet, a physician-patient relationship does not exist in every professional interaction involving physicians and individuals they examine or treat. There are several “third-party” relationships, mostly arising where the individual is not a patient and is merely being examined rather than treated, the individual does not select or pay the physician, and the physician's services are provided for the benefit of another party. Physicians who treat NFL players have a physician-patient relationship, but physicians who merely examine players to determine their health status have a third-party relationship. As described by Glenn Cohen et al., the problem is that typical NFL team doctors perform both functions, which leads to entrenched conflicts of interest. Although there are often disputes about treatment, the main point of contention between players and team physicians is the evaluation of injuries and the reporting of players’ health status to coaches and other team personnel. Cohen et al. present several thoughtful recommendations that deserve serious consideration. Rather than focusing on their specific recommendations, however, I would like to explain the rationale for two essential reform principles: the need to sever the responsibilities of treatment and evaluation by team physicians and the need to limit the amount of player medical information disclosed to teams.

The commentary is here.

Sports Concussions & Psychology

Here is a brief video on psychologists' role in sports psychology and concussions.  The video features PPA's Drs. Rex Gatto and Don McAleer.

Teen Athletes Should Get Concussion Test Score Before Play

-- Robert Preidt

(HealthDay News) -- Individual concussion baselines need to be created for young athletes at the start of a playing season for them to be accurately diagnosed and treated if they suffer a concussion during the season, researchers report.

The investigators also noted that the sex of the players affects the scores on a standardized concussion assessment tool.

The study included 1,134 high school athletes in the Phoenix area who completed a brief questionnaire regarding their concussion history and were given a score based on the new Sport Concussion Assessment Tool-2 (SCAT2).

There were 872 males and 262 females, average age 15, included in the study. The predominant sports were football for the males and volleyball for the females.

Females scored significantly higher than males on the SCAT2 total score, and athletes with a prior history of concussion scored much lower on the SCAT2 than those with no history of concussion.

The findings were slated for presentation Thursday at the annual meeting of the American Orthopaedic Society for Sports Medicine (AOSSM) in San Diego.

"Our results showed that otherwise healthy adolescent athletes do display some variability in results so establishing each player's own baseline before the season starts and then comparing it to test results following a concussion leads to more accurate diagnosis and treatment," study author Dr. Anikar Chhabra, of the Orthopaedic Clinic Association in Phoenix, said in an AOSSM news release.

"This data provides the first insight into how the SCAT2 scores can be used and interpreted as a sideline concussion tool and as an initial baseline analysis. With concussions accounting for approximately 9% of all high school athletic injuries, accurately utilizing assessments like these to quickly determine an athlete's return-to-play probability is critical to long-term athletic and educational performance," Chhabra said.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.